Rib Fixation Device and Related Methods

ABSTRACT

A rib fixation plate is provided that is can have one or more locking rib hooks that can translate and rotate independently from one another. The one or more locking rib hooks translate and rotate when in an unlocked conformation and are secured from translation and rotation when in a locked conformation. The plate includes a first end and a second end opposite of the first end, the second end having a housing assembly configured to receive a rod. The rod can be secured to a vertebra with a pedicle screw.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/007,834, filed on Jun. 13, 2018, the entire contents of which areincorporated by reference as if set forth herein in their entireties.

BACKGROUND Field

The present disclosure relates generally to medical devices, andspecifically to bone fixation instruments and methods for performingsurgical procedures.

Background

The spine is critical in human physiology for mobility, support, andbalance. The spine protects the nerves of the spinal cord, which conveycommands from the brain to the rest of the body, and convey sensoryinformation from the nerves below the neck to the brain. Even minorspinal injuries can be debilitating to the patient, and major spinalinjuries can be catastrophic. The loss of the ability to bear weight orpermit flexibility can immobilize the patient. Even in less severecases, small irregularities in the spine can put pressure on the nervesconnected to the spinal cord, causing devastating pain and loss ofcoordination. Surgical procedures on the spine often include theimmobilization of one or more vertebrae. Immobilizing the vertebrae maybe accomplished in many ways (e.g. fixation plates and pedicle screwsystems). One of the most common methods for achieving the desiredimmobilization is through the application of bone anchors (most oftenintroduced into the pedicles associated with the respective vertebrae tobe fixed) that are then connected by rigid rods locked to each pediclescrew. These pedicle screw systems are very effective. However,vertebrae of pediatric patients can be small, making the use of pediclescrews challenging, and the vertebrae of trauma patients, or patientshaving decreased vertebrae strength, may not have sufficient bonestructure with which to use pedicle screw systems. Moreover, bonestructures of patients vary in size and location based on thatparticular patient's anatomical profile, accounting for physiologicalcharacteristics such as patient age and patient size. Therefore, a needcontinues to exist for new bone fixation devices that can be used asalternatives to pedicle screws and that are also adjustable to use witha wide variety of patients having different physiologicalcharacteristics.

SUMMARY

The present disclosure describes a rib fixation plate, including partsthereof, useful for securing, for example, a spinal rod in multiplespinal surgery techniques. The plate can be used with a rib hook thatcan translate across the plate. The rib hooks can also rotate around anaxis with the plate. The modifiable nature of the rib hooks with theplate confers flexibility to the plate in the types of procedures forwhich it can be used, and allows a surgeon to alter the configuration ofthe rib hook during a procedure as necessary. The rib hook includes alocking element such that the surgeon can lock the rib hook in a securedposition when the rib hook is in a desired lateral and rotationalposition.

In a first aspect, a plate for securing a spinal rod to a rib bone isprovided, the plate comprising: an elongate body including a first endand a second end opposite of the first end, the first end beingconfigured to be secured to a rod; an aperture formed in the body, theaperture disposed along an axis extending from the first end to thesecond end; and a first locking rib hook configured to receive at leastpart of a rib bone. The first locking rib hook is disposed within theaperture and configured to translate within the aperture when the firstlocking rib hook is in an unlocked conformation. The first locking ribhook is configured to be locked against translating within the aperturewhen in a locked conformation.

In a second aspect, a kit is provided for securing one or more bones ofa subject, comprising: a plate including first end and a second end, atrack extending from the first end to the second end, and a rod housing.The kit includes a first locking rib hook configured to receive at leastpart of a rib bone, and which is configured to slidably engage thetrack. The kit includes a rod configured to be secured in the rodhousing, and a pedicle screw configured to secure the rod to a bone ofthe subject.

In a third aspect, a rib fixation plate assembly is provided. The ribfixation plate assembly comprises: a plate including a first end and asecond end, a track extending from the first end to the second end, anda rod housing; a locking rib hook dimensioned to receive a rib bone of asubject, the locking rib hook positioned in the track, wherein thelocking rib hook is configured to translate within the track when thelocking rib hook is in an unlocked conformation, and wherein the lockingrib hook is configured to be secured with the track when the locking ribhook is in a locked conformation; a rod secured with the rod housing;and a pedicle screw disposed on the rod and configured to secure the rodto a bone of the subject. An alternative embodiment of the rib fixationplate is also contemplated, wherein the plate includes an integrated rodextending therefrom instead of a rod housing to receive a separate rod.According to another contemplated alternative embodiment, the plateincludes a lamina hook instead of a rod housing, rod and pedicle screw.

In a fourth aspect, a method of securing a spinal rod to a rib bone isprovided. The method comprises: positioning a rib hook of the plate ofthe first aspect at least partially around a rib of a subject while inthe unlocked conformation; locking the rib hook in the aperture;anchoring a bone anchor to a vertebral structure of the subject; andsecuring the rod to the bone anchor and the rib plate.

The above presents a simplified summary in order to provide a basicunderstanding of some aspects of the claimed subject matter. Thissummary is not an extensive overview. It is not intended to identify keyor critical elements or to delineate the scope of the claimed subjectmatter. Its sole purpose is to present some concepts in a simplifiedform as a prelude to the more detailed description that is presentedlater.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1. An anterior view of an embodiment of a rib fixation assemblyafter placement with a rib bone and a vertebra.

FIG. 2. A perspective view of the embodiment of the assembly of FIG. 1.

FIG. 3. An alternate perspective view of the embodiment of the assemblyof FIG. 1.

FIG. 4. An elevation view of the embodiment of the assembly of FIG. 1.

FIG. 5. Another view of the embodiment of the assembly of FIG. 1.

FIG. 6. Yet a further perspective view of the embodiment of the assemblyof FIG. 1.

FIG. 7. A perspective view of a body of a plate of FIG. 1.

FIG. 8. Another perspective view of the body of FIG. 7.

FIG. 9. A perspective view of a rib hook of the assembly of FIG. 1.

FIG. 10. A front elevation view of the rib hook of FIG. 9.

FIG. 11. A side view of the rib hook of FIG. 9.

FIG. 12. A rear side view of the rib hook of FIG. 9.

FIG. 13. A perspective view of a pedicle screw of the assembly of FIG.1.

FIG. 14. A perspective view of an embodiment of a body of a retractorplate.

FIG. 15. Another perspective view of the embodiment of the body of FIG.14.

FIG. 16. A top view of the embodiment of the body of FIG. 14.

FIG. 17. A bottom view of the embodiment of the body of FIG. 14.

FIG. 18. A left side view of the embodiment of the body of FIG. 14.

FIG. 19. A right side view of the embodiment of the body of FIG. 14.

FIG. 20. A front elevation view of the embodiment of the body of FIG.14.

FIG. 21. A rear elevation view of the embodiment of the body of FIG. 14.

DETAILED DESCRIPTION

Illustrative embodiments of a rib fixation plate are described below. Inthe interest of clarity, not all features of an actual implementationare described in this specification. It will of course be appreciatedthat in the development of any such actual embodiment, numerousimplementation-specific decisions must be made to achieve thedevelopers' specific goals, such as a compliance with system-related andbusiness-related constraints, which will vary from one implementation toanother. Moreover, it will be appreciated that such a development effortmight be complex and time-consuming, but would nevertheless be a routineundertaking for those of ordinary skill in the art having the benefit ofthis disclosure. The rib fixation plate disclosed herein boasts avariety of inventive features and components that warrant patentprotection, both individually and in combination.

The overall configuration of an illustrative embodiment of the ribfixation plate assembly 10 is shown in FIGS. 1-6. In this embodiment ofthe assembly 10, a plate 12 includes a body 14 having a first end 16(e.g., cranial) and a second end 18 (e.g., caudal) opposite of the firstend 16. The body 14 may be elongated from the first end 16 to the secondend 18. An aperture, or track, 20 may be disposed within, such as bybeing integrally formed with, the body 14. The aperture 20 may extend inan axis 22 extending from the first end 16 to the second end 18. A firstlocking rib hook 24 may be disposed within the aperture 20. The firstlocking rib hook 24 may be configured, or dimensioned, to receive atleast part of a subject's 2 rib bone 4. The first locking rib hook 24may be configured to translate within the aperture 20 along thedirection of the axis 22. Thus, the first locking rib hook 24 may becapable of translating between the first end 16 and the second end 18 ofthe body 14. Moreover, the first locking rib hook 24 may rotate around afirst hook axis 26 (shown in FIG. 5). Advantageously, a surgeon canadjust, by translating and/or rotating, the first locking rib hook 24within the plate 12 to fit the anatomical characteristics of the subject2. This feature also allows the surgeon more flexibility in placing theplate 12 within the subject 2. A further benefit of the disclosedembodiments is that the rib hook may be moved and rotated to be usablewith different patient types, such as subjects 2 of varying age(children and adults) and subjects 2 who have had trauma to one or morerib bones, as well as unique anatomical characteristics of subjects 2(varying rib bone shape, varying rib bone size, etc.).

As can be seen in FIG. 1, the assembly 10 may include multiple lockingrib hooks, each similar to the first locking rib hook 24. Theillustrated embodiment shown in this embodiment of the assembly 10 hasthe first locking rib hook 24, a second locking rib hook 28, and a thirdlocking rib hook 30, each of which are configured to receive at leastpart of the first rib bone 4, second rib bone 5, and third rib bone 6,respectively. A benefit to this embodiment of the assembly 10 is thateach rib hook 24, 28, 30 may be translated within the aperture 20, andeach rib hook 24, 28, and 30 may be rotated along a respective firsthook axis 26, second hook axis 32, and third hook axis 34 (as shown inFIG. 5). It is appreciated that embodiments of the assembly 10 maycomprise one locking hook, two locking hooks, or more than three lockinghooks (i.e., four hooks, five hooks, etc.) (not shown).

A benefit of embodiments of the assembly 10 having two or more lockinghooks is that the plate 12 has additional stability against movement,including yaw, pitch, and roll. Yet another benefit this embodiments ofthe assembly 10 having multiple locking hooks is that each locking hookmay be adjusted individually to cooperate with the rib bones of thesubject 2. For example, the locking hooks may be individually translatedto account for varying intercostal space (i.e., the space between tworibs) between adult and child subjects 2. Thus, the hooks may beadjusted regardless of whether the subject 2 is in an adult having atypical adult intercostal space height or a child having an intercostalspace height typical of a child of that age. Furthermore, each rib hookmay be individually rotated along its respective hook axis to cooperatewith each rib it is configured to receive.

The plate 12 may include a rod housing 32 configured to receive a rod34. The rod housing 32 may be disposed at any point along the plate,such as at the second end 18 of the plate 12 as shown in the illustratedembodiments. The rod 32 may be variously secured within the rod housing32. A pedicle screw 36 may be disposed elsewhere on the rod 34 to securethe rod to a vertebra 3 of the subject 2. Advantageously, in thisembodiment, the pedicle screw 36 is configured to secure a bone 3 (e.g.,a spinal pedicle as shown in FIG. 1) that is desired to be immobilizedwithout needing an additional pedicle screw to another vertebra. While asecond, third, etc. pedicle screw could be used with the assembly 10,they are not required as the plate 12 provides support to the assembly10, which is particularly beneficial in child subjects 2, subjectssuffering from decalcification, and subjects who have had spinal trauma10, as these subjects 2 often lack vertebrae that can adequately supporta pedicle screw. Further, the plate 12 may be bendable to providevarying curvature to accommodate the specific rib cage curvature ofindividual patients.

As described in further detail below, the assembly 10 may include a hooklocking element 38 configured to transition each locking rib hook 24,28, 30 between an unlocked conformation and a locked conformation. Thelocking rib hooks 24, 28, and 30 are shown in FIG. 1 a locked positioneach secured to the respective first rib bone 4, second rib bone 5, andthird rib bone 6, and are secured against translation and rotation.

FIGS. 2-6 illustrate the assembly 10 isolated from a subject 2. Theassembly 10 has the first, second, and third locking rib hooks 24, 28,30 disposed at least partially within the track 20. Each of the first,second, and third locking ribs 24, 28, 30 may have the hook lockingelement 38. The rod housing 32 in the illustrated embodiment is disposedon the second end 18. The rod housing 32 may comprise a pair of arms 40configured to receive the rod 34 at least partly therein. The pair ofarms 40 may be integrally formed with the body 14 of the plate 12. Therod housing 32 may include a threaded aperture (not shown) for receivinga rod locking element 42, such as a locking screw, to secure the rod ina desired position with the plate 12. A surface 44 of rod housing 32 mayinclude a tool engagement feature 46 for inserting and rod housing 32during a surgical procedure. The locking element 42 may include aninstrument engagement feature 48 for locking the locking element 42 withan instrument (not shown), such as a driver for reducing a lockingscrew. While not shown, the locking element 38 may include a threadswhich cooperate with a surface of the rod housing 32 having cooperativethreads for receiving and locking the locking element 42. The rodhousing 32 may allow for a rod to be adjusted, such as an angle 50 ofthe plate 12 and the rod 34 in an axis 52 parallel to the axis 22. Asillustrated, the angle 50 is 180 degrees, but may be adjusted, forexample, between 90 and 270 degrees, between 120 and 240 degrees,between 150 and 210 degrees, between 170 and 190 degrees, between 175and 185 degrees, or any combination of ranges thereof.

The pedicle screw 36 may be anchored to a vertebral structure and thensecured to the rod 34. The pedicle screw 34 may have a tulip shapeprofile, having a pair of arms 54 extending oppositely from a screwportion 56. The screw portion may have external threads disposed thereonconfigured to be secured within a pedicle of the vertebra 2. The rod 34may be disposed between the pair of arms 54. The pair of arms 54 mayeach, or both, have a tool engagement feature 58 disposed on an externalsurface 60 of the pair of arms 54 such that the pedicle screw may beinserted and positioned during a surgical procedure. The pair of arms 54may be configured to receive a locking element 62, such as a lockingscrew. The pair of arms 54 may have an interior surface 64 havingthreads 66 (shown in FIG. 13) configured to cooperatively engage withthreads 68 on the locking element 62. The interior surface 64 may have aprofile complementary to the rod 34 such that rod 34 is secured when thelocking element 62 is in a locked conformation (e.g., the rod 34 isreduced and secured with the locking element). The locking element 62may have a surface 78 facing away from the rod 34, the surface 78 havinga tool engagement element 80 disposed thereon for engaging a tool, suchas a driver (not shown) for securing the pedicle locking element 62 withthe rod 34 (e.g., reducing the rod).

The locking rib hooks 24, 28, and 30 are configured to independentlytranslate within the aperture 20 and independently rotate around thefirst hook axis 26, a second hook axis 82, and a third hook axis 84,respectively. The hooks 24, 28, and 30 rotate relative to the body 14 ofthe plate 12 such that they can be in various positions independently ofone another. When in a locked conformation, the locking rib hooks 24,28, and 30 are secured from translation within the aperture 20 andsecured from rotation around the first, second, and third hook axis 26,82, and 84, respectively. Thus, the first hook 24 may be rotated andtranslated so as to receive a caudal part of the first rib bone 4, whilethe second hook 28 may be in translated and in a generally opposingposition so as to receive a cranial part of the second rib bone 5. Thiscustomizability of the location and orientation of the rib hooks 24, 28,and 30 enables the surgeon to adjust the rib hooks 24, 28, and 30 foreach patient and surgical procedure.

Turning to FIGS. 7 and 8, a plate 12 is illustrated with the rib hooksnot shown. The aperture or track 20 may include an indentation or shelf86 configured to receive a rib hook. An embodiment of first rib hook 24is illustrated in FIGS. 9-12. Again, the second rib hook 28, the thirdrib hook 30, or any other additional rib hook, may be of the same designor construction as the rib hook 24. The first rib hook includes a curvedarm 88 for receiving a rib bone extending from a base 90. The base 90may be configured to be slidingly and cooperatively received withinindentation or shelf 86. The hook locking element 38 of the first hook24 may include a post 92 extending from the base 90 oppositely from thearm 88. The post 92 may have threads disposed thereon (not shown) forreceiving a nut 94 having corresponding cooperating threads (not shown).The nut may have an outer contour 96 that is engageable by a driver toolfor transitioning the hook locking element 38 between a lockedconformation and an unlocked conformation. The hook post 92 may includea tool engagement element 39 configured to facilitate the translationand/or rotation of the hook 24, 28, 30 in the track using one or moresurgical tools. The nut 94 may have a gripper external surface 98configured for receiving a gripping tool or to be tightened by hand bythe surgeon during a surgical procedure (not shown).

In an embodiment (not shown), the base 90 of the first locking rib hook24 includes a channel disposed therein for receiving the hook lockingelement 38. The channel within the base 90 may include interior threads(not shown) for cooperatively receiving corresponding threads on thelocking element 38.

FIG. 13 illustrates a detailed view of an embodiment of a pedicle screw36 having a tulip profile, with the screw portion 56 extendingoppositely from the pair of arms 54. The pair of arms 54 have aninterior surface 64 having threads 66 that correspond with the threads68 of the pedicle locking element 62 (as shown in FIG. 6) such that, forexample, the pedicle locking element 62 may be used to reduce the rod 34(FIG. 6) within the arms 54. The pedicle screw 36 has an externalsurface 60 having a tool engagement feature 68 for inserting andpositioning the pedicle screw 36.

FIGS. 14-21 illustrate an embodiment of the plate 12 having a radiusedprofile 102 from the second end 18 to the first end 16, as bestillustrated in FIGS. 20 and 21. The plate 12 has the indentation/shelf86 formed therein shaped complimentary to the base 90 of a rib hook 24,26, 30 and configured to enable the rib hook 24, 26, 30 to move alongthe axis 22 of the aperture 20. The first end 16 may have a notch 100formed therein, and the second end 18 may have the rod housing 32adjacently extending therefrom in a direction perpendicular to the axis22.

Kits for securing one or more bones of a subject are provided hereinemploying pieces of the assembly 10, comprising the plate 12 includingthe first end 16 and the second end 18, a track 20 extending from thefirst end 16 to the second end 18, and the rod housing 32. The kit mayinclude a first locking rib hook 24 configured to receive at least partof the first rib bone 4, the first locking rib hook 24 configured toslidably engage the track 20. The kit may include the rod 34 configuredto be secured in the rod housing 32. The kit may include a pedicle screw36 configured to secure the rod 34 with a bone 2, such as a vertebra, ofthe subject 2. The kit 10 may include multiple hooks, such as the secondlocking rib hook 28, the third locking rib hook 30, or additional hooks.To emphasize, the second locking rib hook 28 and the third locking ribhook 30, or any additional hooks, may be the same as the first lockingrib hook 24, such as being configured to slidably engage the track 20and being configured to lock from translation and rotation with the hooklocking element 38. The kit may include the locking element 62.

Surgical procedures are provided employing the plate 12, comprisingsecuring the plate 12 to one or more bones during or after an incision.By way of example, a method of securing a bone is provided. The plate 12is provided, wherein the first locking rib hook 24 is coupled with thetrack 20 of the plate 12 such that the first locking rib hook 24 isslidably engaged with the track 20. The first locking rib hook 24, thesecond locking rib hook 28, the third locking rib hook 30, or anycombination thereof, may be rotated around a respective axis 26, 82, 84perpendicular to the axis 22 extending from the first end 16 to thesecond end 18 to rationally engage the respective rib bone 4, 5, 6 asnecessary to be properly oriented relative to the ribs. The firstlocking rib hook 24 is slid to engage the first rib bone 4. The firstlocking rib hook 24 is locked in place with the first rib bone and theplate 12 from translational and rotational movement. The second lockinghook 28 may be coupled with the track 20. The second locking hook 28 isslid to engage the second rib bone 5. The second locking hook 28 islocked in place with the second rib bone and the plate 12 fromtranslational and rotational movement. The third locking rib hook 30 maybe similarly positioned and locked. A pedicle screw 36 configured tosecure the spinal bone 3, such as a vertebra, may be engaged with therod, after being secured to the spinal bone 3. The rod 34 may be securedin the rod housing 32 of the plate 12 and of the pedicle screw.

It is to be understood that any given elements of the disclosedembodiments of the invention may be embodied in a single structure, asingle step, a single substance, or the like. Similarly, a given elementof the disclosed embodiment may be embodied in multiple structures,steps, substances, or the like.

The foregoing description illustrates and describes the processes,machines, manufactures, compositions of matter, and other teachings ofthe present disclosure. Additionally, the disclosure shows and describesonly certain embodiments of the processes, machines, manufactures,compositions of matter, and other teachings disclosed, but, as mentionedabove, it is to be understood that the teachings of the presentdisclosure are capable of use in various other combinations,modifications, and environments and is capable of changes ormodifications within the scope of the teachings as expressed herein,commensurate with the skill and/or knowledge of a person having ordinaryskill in the relevant art. The embodiments described hereinabove arefurther intended to explain certain best modes known of practicing theprocesses, machines, manufactures, compositions of matter, and otherteachings of the present disclosure and to enable others skilled in theart to utilize the teachings of the present disclosure in such, orother, embodiments and with the various modifications required by theparticular applications or uses. Accordingly, the processes, machines,manufactures, compositions of matter, and other teachings of the presentdisclosure are not intended to limit the exact embodiments and examplesdisclosed herein. Any section headings herein are provided only forconsistency with the suggestions of 37 C.F.R. Section 1.77 or otherwiseto provide organizational queues. These headings shall not limit orcharacterize the invention(s) set forth herein.

What is claimed is:
 1. A bone fixation plate, comprising: an elongatebody extending along a longitudinal axis from a first end to a secondend, the second end configured to be secured to a rod; an aperture inthe elongate body; a rod housing extending from the second end of theelongate body; and a first locking hook disposed within the aperture,wherein the first locking hook is configured to translate within theaperture in an unlocked conformation, and is configured to be lockedagainst translation in a locked conformation, wherein the first lockinghook comprises a post configured to pass through the aperture and engagea locking element.
 2. The bone fixation plate of claim 1, wherein theaperture extends along the longitudinal axis.
 3. The bone fixation plateof claim 1, wherein the post of the first locking hook extends from abase of the first locking hook, the base configured to abut a topsurface of the elongate body.
 4. The bone fixation plate of claim 1,wherein the post of the first locking hook is partly threaded on anouter surface thereof and the locking element is threaded on an innersurface thereof.
 5. The bone fixation plate of claim 1, wherein thelocking element is configured to contact a bottom surface of theelongate body.
 6. The bone fixation plate of claim 1, wherein the firstend comprises a first length and the second end comprises a secondlength along the longitudinal axis, the first length being smaller thanthe second length.
 7. The bone fixation plate of claim 1, wherein therod housing comprises an upper arm extending beyond a top surface of theelongate body.
 8. The bone fixation plate of claim 1, wherein the rodhousing comprises a lower arm extending beyond a bottom surface of theelongate body.
 9. The bone fixation plate of claim 1, wherein the rodhousing is rotatable relative to the second end.
 10. The bone fixationplate of claim 1, wherein the locking element is configured totransition the first locking rib hook between the unlocked conformationto the locked conformation.
 11. The bone fixation plate of claim 1,wherein the rod housing extends along the longitudinal axis from thesecond end of the elongate body.
 12. The bone fixation plate of claim 1,wherein the rod housing extends laterally from a side of the second endin a direction perpendicular to the longitudinal axis.
 13. A kit forsecuring one or more bones of a subject, comprising: a bone fixationplate comprising a longitudinal axis extending from a first end to asecond end; a track in the bone fixation plate; a rod housing extendingfrom the second end of the bone fixation plate; a first locking rib hookconfigured to receive at least part of a rib bone, wherein the firstlocking rib hook is configured to slidably engage the track in aunlocked conformation; a rod configured to be secured in the rodhousing; and a pedicle screw configured to secure the rod with a bone ofthe subject.
 14. The kit of claim 13, wherein the first locking rib hookincludes a post extending from a base, the base configured to abut a topsurface of the bone fixation plate.
 15. The kit of claim 14, wherein thepost of the first locking rib hook is partly threaded on an outersurface thereof and the locking element is threaded on an inner surfacethereof.
 16. The kit of claim 13, wherein the first end comprises afirst length and the second end comprises a second length along thelongitudinal axis, the first length being smaller than the secondlength.
 17. The kit of claim 13, wherein the rod housing comprises anupper arm extending beyond a top surface of the bone fixation plate. 18.The kit of claim 13, wherein the rod housing comprises a lower armextending beyond a bottom surface of the bone fixation plate.
 19. Thekit of claim 13, wherein the rod housing extends along the longitudinalaxis from the second end of the bone fixation plate.
 20. The kit ofclaim 14, wherein the rod housing extends laterally from a side of thesecond end in a direction perpendicular to the longitudinal axis.